July 27, 2014

Another effective review of how Obamacare could be "an antidote to crime"

Regular readers likely recall a number of posts in which I highlighted ways in which the Affordable Care Act (aka Obamacare) could have a significant impact on a number of criminal justice realities in the years to come. A helpful readers alerted me to this notable new Christian Science Monitor article on this topic headlined "Obamacare for ex-inmates: Is health insurance an antidote to crime?". Here are excerpts:

In the enduring quest to discover what can prevent criminals from reoffending, a new holy grail is emerging: health-care services.

Excitement is stirring inside the justice system, as corrections officials work to link inmates who are leaving custody with health services in their communities, courtesy of President Obama’s Affordable Care Act (ACA). The idea is to enroll thousands of ex-offenders in Medicaid, the federal-state health insurance program for the poor, thus making them eligible for treatment for mental health issues, substance abuse, and chronic medical problems that most have never before consistently received on the outside.

The hoped-for result: a reduction in the share of those who reoffend, and a drop in incarceration costs related to securing public safety. “This is a huge opportunity,” says Kamala Mallik-Kane, who studies correctional systems, inmates, and health policy at the nonprofit Urban Institute. “The unprecedented step of connecting these newly eligible people to health insurance has incredible potential to change the trajectory of inmates to reintegrate back into society and not back into the justice system.”...

[But] it is much too soon to know if the excitement among justice experts is justified. No state or county expects to see, this early, a sea change in its correctional systems, recidivism rates, or health-care costs. And it’s not known, for instance, at what rate ex-offenders who enroll in Medicaid actually use health services in their communities.

Many experts, moreover, are wary of the notion that health reform and access to Medicaid for formerly imprisoned men can truly transform America’s criminal-justice system. “Medicaid enrollment for inmates is not the silver bullet,” says Paul Howard, a senior fellow at the Manhattan Institute, a conservative think tank and director of its Center for Medical Progress.

He suggests that Medicaid, a $265 billion federal expenditure in 2013, is not yielding adequate results for the cost – and that it’s time to take “a long and hard look” before expanding it to serve even more people. “Extending those benefits to a historically transient and difficult population with a whole host of social-issues challenges will not change their approach to health care or [their] behaviors,” warns Mr. Howard.

Enthusiasts for Medicaid sign-ups for ex-inmates build their hopes on research indicating that recidivism rates fall when prisoners and ex-prisoners receive mental health treatment. A 2010 study by David Mancuso of the Washington State Institute of Public Policy, a state-based policy think tank, found that for state residents enrolled in Medicaid and receiving substance abuse treatment, arrest rates dropped by as much as 33 percent compared with rates for those who didn’t receive treatment, leading to lower correctional costs and better public safety.

In any case, about 8 million prisoners leave America’s prisons and jails every year. Since the rollout of Obamacare last October, ex-offenders account for about 1 million of the 6 million new Medicaid beneficiaries enrolled in expansion states.

While incarcerated, prisoners have a constitutionally protected right to health care, with costs usually covered by the state (even if they have their own health insurance). Typically, privately contracted health companies or public hospital systems provide such care. Most jails and prisons have on-site clinics – in some cases, even full-service hospitals.

While some say the quality of prisoner care could be better, it’s more robust than what usually greets indigent ex-inmates on the outside. In many states, inmates who’ve been diagnosed with chronic conditions receive a small supply of medication upon release, but often no medical provider or insurance for refills – creating a gap in their health care. Correctional health professionals across the United States share stories of inmates who get rearrested so they can get medication....

Substance abuse or mental health issues afflict the vast majority of prison inmates in the US. More than 1 million incarcerated people suffer from mental illness, the Department of Justice estimated in 2006 – almost half the total in custody. As for substance abuse, the picture is even bleaker, affecting between 60 and 80 percent of all inmates, found a 2013 report of the US Office of National Drug Control Policy.

The strongest case study might be Connecticut, which has one of the most comprehensive approaches to Medicaid enrollment in the nation. The state runs all its jails and prisons, making change easier to administer uniformly. It has four jails and 11 prisons, holding almost 17,000 inmates. Here, a person making less than about $15,800 a year qualifies for Medicaid.

The link is obvious between greater access to health care and lower recidivism rates, say state officials. “If you don’t feel well, you don’t act well,” says James Dzurenda, state correction commissioner. “The Affordable Care Act gives our released offenders access to health care, which is critical to release offenders back into the community safely, increase public safety, and ultimately reduce victimization.”...

Last year, Connecticut processed 7,794 Medicaid applications from state criminal-justice agencies. In the same period, state prison population and arrest rates dropped by about 3.4 percent, according to reports from the state Office of Policy and Management....

Enrolling in Medicaid does not guarantee an ex-inmate will instantly turn over a new leaf, of course. Moreover, the cumulative effect promises to be difficult to tease out: None of the programs now in place track inmates after they reenter the community, so there is no way to tell if ex-offenders are actually using the health insurance. Often, ex-inmates stick with their former habits of heading directly to emergency rooms for care, driving up public health costs, according to a recent study of former prisoners in Rhode Island.

Comments

This is the fourth or fifth article trumpeting the "benefit" of Obamacare to parolees or inmates. This episode's excuse: Feeling good reduces recidivism! And Obamacare makes sure the individual feels good! Without it, he'd feel bad! And then he would jack someone up, rob another liquor store, commit felony rape, or whatever! See? See?

I don't want to rehash the Obamacare argument; many of you on group plans (the majority of you full-timers and students) will feel the pain next January in any case. But I suspect that health care is well down the list for the average released inmate.

Posted by: Eric Knight | Jul 27, 2014 11:36:27 PM

But isn't the goal of releasing criminals to save money? Doesn't giving them free health care fly in the face of the "savings" gained by releasing them?

Hey, "Libertarian" Doug Berman, you are against the ACA just like all of your fellow libertarians, right?

Posted by: TarlsQtr | Jul 28, 2014 8:43:24 AM

W/o ACA a person will feel bad? Seriously?

The "excuse" here is that part of dealing with crime has a health aspect, including drug treatment and mental health issues, both which can lead to crime.

There are various reasons to release criminals at certain times, including because it is the best policy not to just warehouse people when releasing them will further penological ends in the process.

I don't take Doug Berman as a pure libertarian. Even traditional libertarians do accept some basic safety net, which Medicaid can include. ACA also uses a free market friendly approach -- insurance companies, not the government, provide health insurance for those able to afford it under its tenets. A public option was not included. It is not "Medicare for all." The "libertarian" value of rising health care costs where loads of people go bankrupt or only pay a fraction of their bills, which is passed along to the rest of us is unclear to me. But, anyway, I don't take Berman as some pure libertarian anyway.

I sure would hope you do not see "Libertarian Doug™" as a "pure" or any other type of libertarian. He just plays one in public when his goals coincidentally (and rarely) coincide with libertarian goals.

You stated: "ACA also uses a free market friendly approach -- insurance companies, not the government, provide health insurance for those able to afford it under its tenets."

You either have no understanding of the ACA or need an economics course. No law where the government dictates what must and must not be included in a product can be called "free market friendly." It is much closer to fascism (think economics, not Hitler/Mussolini).

I quote: "Restore and revive a free market health care system. (May 2008)
Government should not be in the health insurance business. (Jul 2000)" http://www.ontheissues.org/Libertarian_Party.htm

Posted by: TarlsQtr | Jul 28, 2014 10:42:46 AM

As to just exactly what is a free market, I am reminded of this quote from G.K. Chesterton:

"The poor complain that they are governed badly. The rich complain that they are governed at all."

Posted by: Fred | Jul 29, 2014 10:05:29 PM

I don't think Prof. Berman is a "libertarian" but who knows -- the term is vague.

The use of sneering makes a reply of questionable value, but in this society, and most societies, there is not a pure free market. Yes, in various ways, especially compared to possible alternatives, ACA sets up a more free market friendly approach -- PRIVATE insurers are a primary provider. It isn't the government itself, it is a variety of insurance companies.

The government sets forth certain basic minimums but overall insurers compete and there are a variety of options. People can also not buy any insurance and pay a higher tax.